Treatment Options for Heart Failure Expands With Finerenone | ACC 2025

At the American College of Cardiology 2025 meeting in Chicago, John W. Ostrominski, M.D., a fellow in cardiovascular medicine and obesity medicine at Brigham and Women’s Hospital and Harvard Medical School, discussed the growing evidence supporting the use of Kerendia (finerenone) in heart failure treatment in this part two video interview series.

Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has been studied extensively in patients with mildly reduced or preserved ejection fraction.

According to Ostrominski, findings from the FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure) trial, a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction, and its secondary analyses have provided deeper insights into the drug’s benefits and risks.

One analysis of 6,001 patients found that those enrolled within seven days of worsening heart failure had over twice the risk of cardiovascular events compared to those enrolled later or without prior worsening heart failure.

Finerenone reduced this risk more effectively in patients with worsening heart failure, particularly within seven days.

The drug also didn’t increase adverse events such as hyperkalemia or kidney issues.

“I think what we've progressively learned from not only the main heart kind of FINEARTS-HF analysis but also from the additional secondary analyses that have been published is you've learned really a great deal about the overall benefits and the overall risks of finerenone in persons with heart failure with mildly reduced or preserved ejection fraction,” Ostrominski said in an interview with Managed Healthcare Executive editors.

Beyond its role in slowing heart failure progression, research has shown finerenone’s potential benefits in reducing the risk of new-onset diabetes and atrial fibrillation.

Ostrominski shared it has also been evaluated in patients with chronic kidney disease, providing reassurance regarding safety concerns such as hyperkalemia.

A key takeaway from these analyses is the compatibility of finerenone with sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of medications already strongly recommended in heart failure guidelines.

This suggests that finerenone could be integrated into current treatment plans to improve patient outcomes.

With its demonstrated effectiveness and tolerability across a number of populations in its trials, Ostrominski believes finerenone should be considered a treatment option for patients with symptomatic heart failure and mildly reduced or preserved ejection fraction.

The growing body of evidence may create discussions about its inclusion in clinical guidelines, expanding therapeutic options for heart failure management.